Optimizing Alveolar Cleft Reconstruction: Enhancing Bone Regeneration Through Segmental LeFort I Osteotomy and Tertiary Gingivoperiosteoplasty

Alveolar repair in adult patients with cleft lip and palate presents significant challenges. This retrospective study evaluated bone volume and arch stability following alveolar cleft repair using segmental LeFort I osteotomy combined with tertiary gingivoperiosteoplasty (tGPP), assessed through cone-beam computed tomography (CBCT). Thirty-five patients with cleft lip and palate were included: 19 underwent orthognathic surgery with one-piece LeFort I osteotomies, and 16 underwent segmental LeFort I osteotomies with tGPP. CBCT scans were obtained at 3 time points: T0 (preoperative), T1 (postoperative), and T2 (≥1 y postoperatively). Surgical (T1-T0), postsurgical (T2-T1), and overall outcomes (T2-T0) were analyzed. Bone volume was measured at 4 axial levels (cementoenamel junction, 75% bone level, root mid-point, and apex), and arch stability was assessed and compared between groups. The results showed no significant differences in bone quantity or arch stability between the segmental LeFort I with tGPP group and the one-piece LeFort I group. These findings suggest that segmental LeFort I osteotomy with tGPP provides comparable outcomes to traditional one-piece LeFort I osteotomy in terms of bone regeneration and arch stability. In conclusion, orthognathic surgery incorporating segmental LeFort I osteotomies closed with tGPP is a reliable and effective approach for alveolar cleft repair in adult patients with cleft lip and palate.